A Good Way to Improve Nursing-Home Care

A “culture change” to a more residential atmosphere in nursing homes can lead to significant improvements in quality of care, according to a new study.

Researchers from Brown University examined the effect of culture change – an adjustment in nursing homes to allow a more flexible lifestyle for patients. Specifically, that means, among other adjustments, more resident choices in schedules and activities, and more input into care management from “front-line” workers who have close daily contact with residents.

As examples, the researchers suggested that residents might become able to decide when to go to lunch, while nurse’s aides might have significant input into designing care for a patient.

The investigators, led by Susan Miller, professor of health services policy and practice at the Brown University School of Public Health, looked at 824 facilities that had implemented cultural change between 2005 and 2010.

They found that the homes that implemented the highest degree of culture change showed statistically significant improvements: More residents were in bladder-training programs, while there were reductions in the number of residents who required restraints or feeding tubes, or who had pressure ulcers. The researchers also found a reduction in resident hospitalizations.

In homes that implemented less culture change, there were no similar improvements, while urinary tract infections and hospitalizations were slightly worse.

Some indicators of quality of care didn’t improve. The percentage of patients who had advance directives or who were on antipsychotic medications didn’t change. The number of falls remained the same, although some elder-care experts feared that there would be more falls under culture change.

“It seems to be a valid notion to improve quality with adoption [of cultural change] when you really adopt the philosophy and are doing a lot,” Miller said.

The findings were published in the Journal of the American Geriatrics Society.